Abstract
Purpose::
To obtain information about the frequency and perceived importance of techniques and products used in diagnosis and management of dry eye by eye care professionals.
Methods::
A survey instrument was designed in which respondents considered two hypothetical patients with dry eye. Patient A had no risk factors for autoimmune disease and Patient B had risk factors for autoimmune disease and more prominent subjective complaints. Response to the survey was voluntary and anonymous.
Results::
With 100 surveys tabulated, all eye care providers were most likely to evaluate Patient A with corneal fluorescein stain (oph. 96%, optom. 100%, cornea 100%) and tear break-up time (oph. 81%, optom. 100%, cornea 100%). For patient A: all providers were likely to use Restasis (oph. 69%, optom. 58%, cornea 50%) and, among providers using Restasis, it averaged 4th line agent for ophthalmologists and optometrists and 3rd line agent for cornea specialists. All providers were most likely to evaluate Patient B with corneal fluorescein stain (oph. 92%, optom. 100%, cornea 100%) and tear break-up time (oph. 77%, optom. 97%, cornea 88%). For Patient B, all eye care providers were likely to use Restasis (oph. 92%, optom. 86%, cornea 89%) and, among providers using Restasis, it averaged 4th line agent for ophthalmologists and optometrists and 3rd line agent for cornea specialists. All providers were unlikely to use laboratory tests to evaluate Patient A (% selecting no lab workup: oph. 100%, optom. 97%, cornea 84%). Cornea specialists were more likely than other providers to use laboratory tests to evaluate Patient B (% selecting no lab workup: oph. 58%, optom. 56%, cornea 24%). Among providers who would order lab tests for Patient B, most selected rheumatoid factor (oph. 91%, optom. 94%, cornea 90%). Antinuclear antibody test was next most commonly selected by ophthalmologists and optometrists (oph. 82%, optom. 44%). Cornea specialists were likely to order SS-A (68%) and SS-B (63%) autoantibodies in addition to ANA (53%).
Conclusions::
Corneal fluorescein stain and tear break-up time are most commonly used to evaluate dry eye. Providers are more likely to evaluate patients with risk factors for autoimmune disease with laboratory tests. Cornea specialists are more likely than other providers to use laboratory workup to evaluate dry eye patients. Restasis is commonly used by all eye care providers, but not as first line therapy. Rheumatoid factor is the most commonly ordered lab test in dry eye patients with risk factors for autoimmune disease.
Keywords: cornea: tears/tear film/dry eye • cyclosporine • cornea: clinical science